A study on the effectiveness of an ADHD drug on Binge Eating Disorder was published in the journal JAMA Psychiatry. Doctor Freedhoff explains the significance on his blog, Weighty Matters, in the post from January 15:

Yesterday a study was published in JAMA Psychiatry. In it researchers looks at the impact of 14 weeks of 3 different doses of lisdexamfetamine (Vyvance) on binge eating disorder and weight in 260 patients via a randomized, double-blind, parallel-group, forced dose titration, placebo-controlled trial. Eligibility for the study included meeting the DSM-IV criteria for binge eating disorder, having a BMI between 25 and 45, and being between the ages of 18 and 55. There were a boatload of exclusion criteria with perhaps the most important being having any other eating or psychiatric disorder, having had a history of substance abuse, or having been recently treated with a psychostimulant, or having had a recent psychological or weight management treatment history.

The study's primary endpoint was the number of self-scored binge eating days, and among the secondary endpoints was weight.

The results were striking, especially in those taking the highest dose who nearly stopped binging.

Weight loss was also not insignificant, again, especially with the higher dose, with those folks losing an average of nearly 10lbs over the 11 weeks (versus an average loss of 1/5th of a pound for those taking a placebo).

Unfortunately there were also side effects with dramatically more people in the highest dosing arm reporting dry mouth, and insomnia. All told 5% of the highest dosing arm dropped out due to adverse effects.

While far from conclusive, this study is promising. Binge eating disorder is a tremendously difficult condition to endure. Psychologically it can be devastating due to overwhelming feelings of guilt which in turn can lead to decreased self-esteem and decreased perceived self-efficacy. Right now treatment for binge eating disorder involves cognitive behavioural therapy, and indeed, there's fair success, but were there a safe medication that could be used as an adjunct to counselling, speaking personally, I'd be thrilled.

There's still lots of work to be done to prove long term efficacy, safety, and tolerability. Fingers crossed.


What I find the most heartening about the study is the fact that it was even done. So much money is invested in magic weight loss pills, where the focus is on how to burn fat or alter the body ... especially without having to change eating or exercise habits. Whether Vyvance is as effective as it appears to be, based on a preliminary and relatively small study, I like that they're (a) looking for drugs which help to alter behaviour, and (b) that B.E.D. is being taken more and more seriously as a legitmate psychological condition.

It's a small ray of hope, but it's still a ray.

What holds you back from reaching weight loss goals? Why is it easy to start diet or exercise regimens, yet so hard to maintain them? For me, part of it is because when I got close to where I thought I wanted to be, I looked around and realized that the grass was not as green on the other side as I'd expected. And that can be demoralizing. "I did all of X, Y, Z, and still A and B haven't changed?"

Following the path to happiness through weight loss. Is there any bigger fairy tale fantasy out there?

I bought in to the Fantasy of Being Thin from an early age. It's an idea I'm working hard to let go of, with some difficulty, because no matter how rational or logical I try to be about it, the idea that being thin or losing weight is the solution to all your problems is reinforced left, right, and centre. See, we're sold on the idea that life will begin when. You will be good enough, worthy enough, WHEN. When you lose enough weight. When you are thin enough. When you are strong enough, healthy enough, fit enough. So, weight loss and/or the body becomes the focus, and if that happens, you often tend to put your life on hold. Waiting. Just waiting until.

Weight Stigma is about buying the magic beans. Believing that, if you can just lose enough weight, you'll climb your beanstalk to find whatever it is you're lacking. Happiness, love, acceptance, health, money, fame, revenge. So, you work and you work, and you climb that beanstalk, and all you find is yourself, in the clouds. Without having enjoyed the view on the way up, at all.

It is a pervasive sentiment. And it's not just in the obvious places like media or industries which stand to profit from people feeling bad about themselves. It's, well, everywhere. In fact, years ago when I was in counselling - clearly talking about body image as a direct connection to low (damn near non-existent) self esteem - the therapist suggested that perhaps I would be happier if I lost some weight. Yeah. This happens in real life. The fantasy was reinforced by a professional: the key to accepting yourself is ... to change yourself? "Most healthcare providers and therapists want nothing more than to relieve suffering and enhance the health of our patients.  Both patient and provider may think the obvious solution is to try to leave the stigmatized group and try to lose weight. But participating in the illusion that weight loss is possible, desirable, and the only way to have a good life, is to perpetrate weight stigma." 

The topic of Weight Stigma and Psychotherapy was addressed as part of Weight Stigma Awareness Week. The article called "Surprises when you venture off the eating disorders island" is about how so deeply ingrained the belief is that weight loss leads to happiness, that even well-trained psychotherapists recommend it, despite evidence that such a suggestion (or judgement) has the opposite effect. In other words, the fairy tale is retold; the therapist is selling magic beans.

And, I think, buying in to this fantasy that weight loss is the solution to all of life's problems leads to self-sabotage. I mean, there are lots of reasons that we take ourselves down, when we go against what we think we really want. (It's called cognitive dissonance, and I've written about it before). Maybe it's an esteem or confidence issue, when you really think you're not good enough. But, more often, I think it's because we have internalized a message that is so ubiquitous that it is reinforced and repeated in all areas of our lives: that getting thin is the answer. What happens when you get there, or when it becomes within view, and you all of a sudden realize that it is NOT the answer to all of life's problems? It's only the answer to some health issues.

One of the best pieces I've come across that helps me to combat those kinds of suggestions, one I go back to often, is Kate Harding's post on The Fantasy of Being Thin. It's what I need to remind myself of often. It's even more honest than the generic "love your body, love yourself" message that abounds in marketing campaigns and women's magazines. She lays it on the line: focusing on weight loss as the answer to life's problems (ie: the things we don't like about ourselves) only masks those problems. 
"All of those concrete things you’ve been putting off? Just fucking do them, now, because this IS your life,
happening as we speak. But exhortations like that don’t take into account magical thinking about thinness, which I suspect  is really quite common. Because, you see, the Fantasy of Being Thin is not just about becoming small enough to be perceived as more acceptable. It is about becoming an entirely different person – one with far more courage, confidence, and luck than the fat you has. It’s not just, “When I’m thin, I’ll look good in a bathing suit”; it’s "When I’m thin, I will be the kind of person who struts down the beach in a bikini, making men weep.”
Changing your weight in the hopes of changing your identity? Doesn't work. It's magical thinking at its beanstalk best. Or worst, really.

So, self-acceptance - acknowledging who you REALLY are, and what you REALLY want - is more than body acceptance, even though the two often intersect. And this is a hard pill to swallow. The magic beans of "change your weight, change your identity," where all your hopes are pinned on weight loss, they're much more palatable. Because, when you buy the magic beans, you don't have to examine your true self.

There are some things about me that aren't going to change, no matter what size I am. Losing weight will not make me any better at math. Being thin isn't going to magically make me more creative than I already am. Gaining weight isn't going to make me any less pragmatic, or funny, or caring, or control-freak-ish. The things I like about myself? They exist at every weight. So, too, will the things I don't like about myself. Rather than putting all of my eggs into the "lose weight, feel better" basket, I'm trying to separate out the things that I can change from the things that I can't, and work on getting healthy only for the sake of health. This yellow-brick-road journey is long, but worth it.

A huge part of health and fitness, to me, is working on letting go of the idea that losing weight will somehow change you into someone you're not already, and on accepting who you are right at this moment. Frankly, it's the reason I insist on getting pictures of myself doing active, fun, adventurous things. I still don't love how I look in them, but I need the proof, the reminders, that I summited a mountain, went rock climbing, white water rafted, worked at camp, travelled the world, and I did it while being varying degrees of fat. That comes directly from having read The Fantasy of Being Thin. Not waiting until the end of my weight loss journey for my life to start.

Is something holding YOU back? What Fantasy have you bought into, that thing that you're waiting until, before you feel whole? What's at the top of your imaginary beanstalk? Because, if it's keeping you stuck where you are, it may be time to chop that thing down.

Taking ownership over your own actions and not playing the victim, it's a little bit like throwing away the magic beans, picking up a rake and a hoe, and tending to the garden you have.

I got an email from CRC Health Group, "a national behavioral health care company. CRC recently created a graphic which I believe helps to illustrate "almost" anorexia. I thought I would send this over to you in case you felt your readers would benefit from it. A copy of the graphic is embedded which you are free to publish as you see fit. Thanks for your time and all that you do to educate your readers about eating disorders."

Well. This is kind of cool. The information is coming to ME, now.

While Anorexia has not been part of my own journey or Binge Eating experience, I'm obviously pretty aware of the complexities of eating disorders, and even how some symptoms and behaviours can have cross-over between the official diagnoses. In fact, I've already written about the prevalence of "almost" disorders, because when those are factored in, it makes one ask "is disordered eating the new normal?"

This graphic is based on a book by Jenni Schaefer, called Almost Anorexic.

From the CRC Health website:
We created the above infographic to generate awareness about a phenomenon that recently came to our attention called “almost anorexic.” There are a lot of gray areas around the diagnosis and treatment of anorexia(and all eating disorders), and these disorders are becoming more prevalent in the United States (and around the world).

While only 1 in 200 adults meet the clinical diagnosis of anorexia, 1 in 20 people meet the criteria to be considered almost anorexic. The percentage is much higher for teen girls.  Since eating disorders are among the deadliest of all mental disorders, our treatment community is urgently reaching out to improve awareness about the symptoms and warning signs of anorexia.

Awareness and information is crucial and can save lives. It's not just the librarian in me saying that. If you see yourself or a loved one in these descriptions, check out crchealth.com for suggestions on how to find help.

I have several posts half-written, all on topics that feel ... big. Not ones to just hammer out and hit "publish" recklessly. So, in the meantime, as I enjoy the beautiful summer weather outside and away from a computer, as I wind down our busy summer programming and start to think about vacation time, here's a video I've been holding on to for awhile.

It's not about weight loss or nutrition or exercise, specifically. It's not even just about sexuality, though that's the foundation from which she begins. It's about being honest, with yourself and with others. And if that doesn't relate to every aspect of health, then I don't know what does. Any change begins with a deep breath and getting real.

First, watch this video. Even if you've seen it, you'll want to see it again. It's pretty amazing:

"We all have closets. All a closet is, is a hard conversation. Hard is not relative. There is no harder. There is just hard. Inside, in the dark, you can't tell what colour the walls are. You just know what it feels like to live in a closet. At some point, we all live in closets and they may feel safe, at least safer than what lies on the other side of that door. No matter what your walls are made of, a closet is no place for a person to live. When you keep the truth about  yourself a secret, you are essentially holding a grenade. If you do not throw that grenade, it will kill you."

When I first saw this, it resonated so much with me, because living in a morbidly obese body was a lot like living in a closet. It was one that the world could see, unlike other closets she mentions. I may not relate directly to the traditional "coming out" experience, but I can understand what it's like to have to hide your identity. Enough people have responded directly to my posts about Binge Eating Disorder with some element of surprise and gratitude and the sentiment "you're so brave to put that out there" that I understand even more just how much I hid for a very long time.

She nails it with the grenade analogy. Hold on to something for too long and it will explode in your hand. Whether it's anger, hurt, negativity, or a secret, holding on to anything but love, hope, and happiness will eventually blow up all over you. I have a forum now, a way to come out about whatever I want to, and it no longer feels brave when I do. It just heals. I am now trying to figure out not only who I want to be, but who I *am.* Who I might have been if I hadn’t arrested my development at the angsty teenage years. If I had stepped out of my closet, and truly lived.

Identity is huge. I don’t want to just be the fat girl. I don't want to be the formerly-fat-girl. I don’t want to be the girl with the eating disorder. I just want to be … me.

The thing is, now that I can finally fit into a closet, I don't want to live there.

I've been mulling over how to write about the dichotomy between finding balance and losing weight. What I've been stuck on is the angle from which to approach the topic. Can I re-lose the weight I've put back on, and continue to lose, while still aiming for a balanced approach to health?

It doesn't feel like it. And I wasn't sure why. But I think it's because for binge eaters, there IS no balance. Just as an alcoholic can't have "just one drink", there are some foods which I can't have just a little of. There is no such thing as "just one bite" when you're not able to stop, so cheat meals or occasional indulgences don't work the way they do for most people. Which, y'know, could be fine except that I can't stop eating altogether and go "dry" to sober up.

But maybe I'm not as alone as I thought. Diet talk is everywhere. Mixed messages are everywhere. Confusion is, well, everywhere. An article I've been holding on to brought the point to the forefront: Diet talk has become inescapable. "Many of the behaviors that today’s diet books and food trends promote are straight out of the DSM Diagnostic Criteria for Eating Disorders. Preoccupation with food and eating, making excuses for not eating, elimination of large categories of food, rigid food rules and rituals, guilt and shame associated with food and eating, avoidance of social activities because of anxiety about food, isolating oneself from friends and loved ones because of dietary ideology, the list goes on. These are not normal or healthy behaviors, they are hallmarks of disordered eating, and they are PROMOTED in diet books and blogs and between friends, with distressing and escalating regularity."
She concludes that we are, as a culture, developing a collective eating disorder. What started as a desire to improve the quality of our diets has turned into a national obsession.

It makes it pretty difficult to distinguish between truly disordered eating habits, and healthy habits. Where do you draw the line? How do we recognize in ourselves or others when it has become a problem? Another recent article attempts to shed light on "the most common eating disorder you've never heard of." The problem is that they've taken the designation of Other Specified Feeding or Eating Disorder - which is a catch-all category used to diagnose anything other than anorexia, bulimia, and binge eating disorder - and called it "the most common." That part doesn't make sense, but what is striking from the article are the statistics. It sheds light on how many people fall on the eating disorder spectrum. Most often, the focus is only on those who are at the farthest end.

Consider some of these statistics:

• One in 68 adults will develop clinical anorexia, bulimia, or binge eating disorder, but at least one in 20 have demonstrated symptoms of these disorders.
• 74.5 percent of women said concerns related to shape and weight interfered with their happiness.
• In one study on adolescent boys and young men, 17.9 percent reported becoming “extremely concerned” with their weight and physique by adulthood.
• One in 20 adults exhibits symptoms of an eating disorder, and the prevalence of dieting and disordered eating behaviors among male and female young adults is particularly high.
• Among women ages 25 to 45 without a history of anorexia nervosa or binge eating, 31 percent reported having purged as a means of weight control.

Dieting and poor body image don't mean you have an eating disorder. But your behaviour doesn't have to be extreme in order to have one, either. The best way to consider whether there's a problem to address is to ask whether your relationship with food, shape, and weight is truly interfering with your life. Ultimately “the main feature that cuts across all eating disorders… is feeling like your shape and weight is one of the most important factors that determines how worthwhile you are as a person,” Dr. Thomas says.

When I lived out west, I met the clinical criteria for Binge Eating Disorder: "eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of being embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after overeating; a sense of lack of control over eating during the episode; at least two days a week for six months."

I no longer meet that criteria. The work I've been doing, on my own, with Mat, with doctors, by blogging, has helped tremendously. But I will probably always call myself a binge eater. I don't know what "recovery" looks like, or if there is such a thing. I really do think of it in terms of an alcoholic. It's always going to be there, under the surface. As evidenced by this weekend's near-binge, moments of relapse can happen without warning, at times that aren't obvious. That's kind of scary to me.

Which brings me back to my conundrum. All-or-nothing thinking is a big part of the problem that got me into this mess in the first place. If I can't be perfect at eating all the time, why bother? If I mess up a diet, then I give in and go overboard the other way. If I'm not good at an activity right away, then I must not be able to do it at all. You see where I'm going with this? All-or-Nothing is the hallmark of a lot of eating disorders. That's why I'm striving for balance. And, yet, I'm not sure that balance is really, truly, possible when it comes to eating. There ARE whole categories of foods I have to mentally eliminate and take off the table. I DO need to track what I'm eating and weigh myself and account for it all. There still is fear, for me, around food: there's something "bad" about everything, so nothing feels "safe"! And certain foods will likely always be triggers. Not exactly the definition of balanced.

It tells me that there's still a long way to go. But also that it's possible and there is hope, even if that hope is to inch along the spectrum back towards the middle. I think I believed that I could jump from one end to the other - all-or-nothing - and that it could be like flicking a switch. Make the lifestyle changes, lose weight, get into shape, you're done, move on. It's not like that, at all. I don't know why I thought it would be. Like much of the population, I'm living in the grey areas, the always moving grey areas between the ends of the disordered eating spectrum.

When 1 out of 20 are also living there, at least I know I'm in good company.

Also known as "why I will continue to workout."

Confession time: I did something dumb. I went grocery shopping while I was hungry, when I knew I was craving sugar. I walked in to the store with the intention of getting two glazed croissants, very specific donuts that are only made at Zehrs. Only, they didn't have any on that day.

For most people, that would be the end of it. Or, they would just choose another kind of donut from the full rack. But there are some foods which, once they're in my head, I need to either have or replace with something similar. See, I'm pretty specific when it comes to cravings and binge eating and what I can and can't say no to. I'm learning what items are the dangerous ones that signify the start of the spiral, and that if I can just avoid THOSE, I might be okay. With the donuts, I thought "if I can just have one or two and get out of there, it's bad but it's not over-the-top bad, and the icing/sugar craving will be satisfied and go away."

I am able to walk away from every other kind of donut they have in their bakery, except these glazed croissants, so I didn't put anything into the paper bag. But the sugar craving was still there, and the seed of a binge had been planted, and I knew I was in trouble. Heart rate increases. Face gets warm. I keep shopping, though, because I need groceries, especially the good stuff that will sustain me, like fruits and vegetables and cottage cheese and eggs. Aisle after aisle, I look at items that are on my mental binge-trigger "bad" list. I walk away from the cookies. I walk past the ice cream. I pause but keep moving past the chocolate bars, especially the Aero Bubbly mint ones. There are some aisles I do not even go down. With every item I say no to, my heart rate goes up, so by now I'm actually sweating. I know what it is I want. I try to talk myself out of it. It's like there are two voices in my head, and I honestly don't know which one is stronger. When I get like this, it's a little like being in a trance. I see it happening from far away, there is still a voice in my head trying to rationalize and argue why I should walk out of the store, but my body doesn't listen. It turns back towards the bakery.

In the end, I fall back on a very old habit. I buy a single-layer vanilla celebration cake and a jar of cream-cheese flavoured icing, because what's on the cake itself is not enough.

I haven't talked very much about the specifics of Binge Eating Disorder because, frankly, it is humiliating. I've alluded to it a bit, but never described it or admitted to what I do when I binge. Normal people don't consume an entire cake by themselves. But, there I was, with no explanation as to why I was lapsing. It's been awhile since I've had a true binge. I can't honestly say what started this one, since I've been happy, on track, and doing well lately. I just woke up craving sugar and couldn't shake it, I went to the grocery store hungry, and I fell into an old vice.

Bear with me; there is a silver lining to this story. Because I ended up throwing most of the cake out.

After putting the entire jar of icing on the cake, licking the knife, and having a few frantic bites - one never binges slowly, it is always urgent - I checked my watch. It was close to the time that Group Core was meant to start, and I had said I would be there. Decision time. Go and work out, or stay and eat? I had a few more bites of cake, got dressed, and went. The craving had been temporarily addressed, and I knew the cake would be waiting for me when I got back. So, I went and worked out.

I have never been able to interrupt a binge, once begun. I am getting better at talking myself out of starting, of exercising some degree of willpower and not putting myself into dangerous situations in the first place, but I've never, ever stopped mid-binge. Once the dam of willpower breaks, the food flood leads to a feeding frenzy. Except for this time. When I got home, after Group Core class, I felt different. Sweaty. Tired. Good. Maybe it was the endorphins. Maybe it was just the interruption itself. But the workout worked. And I put the cake into a garbage bag and took it directly to the dumpster.

That same afternoon, one of the fitness week-in-review emails that I subscribe to linked to an article arguing whether we are really exercising less than a few decades ago. It's a great example of how science can easily be misinterpreted, and data manipulated, but the argument is that we are not actually moving much less than ever and still we collectively continue to grow. The conclusion is that exercise has little impact on weight loss or weight management.

The longer I work at this weight thing, the more I am coming to accept that fat is all about food, and exercise correlates to strength and health. At least , the way I do it, it seems to. If I really want to lose the belly, lose the weight, ever hope to be skinny-ish, it's going to be from even more major changes to eating than I've already made. I wanted to believe that if I just worked hard enough, if I exercised often enough, long enough, intensely enough, I could make the 'calories in, calories out' sum work. I wish it worked that way. It really doesn't. It's all so much more complex than that.

But exercise does have an impact on my weight. It may not be from thermodynamics, burning off more than I consume. The mental influence a workout has on losing weight is harder to measure scientifically, yet for me it can't be underestimated. Even when working out and getting sweaty leaves me hungrier, it also helps me to make better choices because I know how hard I've worked and I don't want to undo that. The endorphins lift my mood. I create energy which then doesn't leave me tired, in need of a quick sugar fix. I get out of my apartment, around other people, and physically interrupt the binge pattern when I walk in to the Y or step onto a hiking trail. I don't feel quite so bad about myself after working out, and in the absence of guilt or self-loathing, the power of binge eating is reduced. Most importantly, exercise helps me to think more clearly.

I don't know if I will always be able to interrupt a binge. This is new territory for me. The fact that I've done it once gives me hope, though. It's one more tool in the arsenal.

When in doubt, I'll go work out.